Healthcare Provider Details

I. General information

NPI: 1407071129
Provider Name (Legal Business Name): BRENT L DEUINK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 CLYMER-CORRY ROAD
CLYMER NY
14724-0308
US

IV. Provider business mailing address

327 CLYMER CORRY ROAD P.O. BOX 308
CLYMER NY
14724-0308
US

V. Phone/Fax

Practice location:
  • Phone: 716-355-4244
  • Fax: 716-355-4244
Mailing address:
  • Phone: 716-355-4244
  • Fax: 716-355-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number035694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: